September 3, 2012

Own goal

Stuff has an article about the breast-milk ‘Brestapo’. It’s a signifier of how obsessive and deranged many mid-wives are about breast-feeding vs formula that they’ve managed to turn the irrefutable fact that breast-milk is healthier into a raging controversy.

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Yup, we all know that breast is best and the best for your baby, if you can do it. If not it should be patently clear that its fine to use formula, its not some sort of devils mouthwash that will turn babies into homicidal maniacs… or does it?

Doubt they give a rat’s about the facts: just spotty schoolboy enthrallment at the attention-gtrabbing and oh-so-witty Breastapo word. The exact equivalent of NATZI for the National Party, but midwives don’t own the press or fake mortal offence at puerile inanities.

We had a nightmare with the breastfeeding police. My amazing wife persevered through endless negative comments, lactation consultations, endless hours on a breast pump (largely ineffective) and at least two incredibly painful bouts of mastisis. Eventually even our pro-breastfeeding midwife relented and acknowledged that sometimes breastfeeding doesn’t work and it’s Ok to give up.

I blame the incentive structure at the hospitals. They have targets around breastfeeding rates on the ward which drive them to push breastfeeding with evangelical vigour. This goes completely against the idea of patient centred care. The first and only objective for ward nurses should be “I am here to support, encourage and care for mothers at one of the most emotionally and physically demanding times of their life”. Some of them live and breath this philosophy and others seriously need to consider a career change.

Its a vexed area of political strategy. Some people who feel marginalised (as breast-feeding once was) think the solution is to yell really loudly until you can’t be ignored – the political version of an insurgency. But that is a divisive strategy that turns a lot of people into enemies and only works if the establishment eventually decides it has to listen because the ongoing cost you’re causing them isn’t worth it – and that only happens if you have enough power to really hurt them in the polls. The other approach is more like Ghandi’s. Be so reasonable that you win over public opinion and then you can’t be ignored by the government without looking bad and losing support. Appeal to the public’s sense of justice, rather than be an irritant. That tends to be better for the level of political discourse and social harmony in the long-run, and it tends to work much better in liberal democracies.

What’s healthiest is a loving and nurturing relationship between a mother and child. If breast feeding stands between that, it is not in the long term interests of either, no matter how physically nutricious the milk might be.

Deano, it might work better in the general case, but when it comes to “women’s issues”, and relatedly to issues important to other marginalised groups but not to those who control the policy process, it has historically had an incredibly poor success rate. A bit of mongrel goes a long way.

I don’t think it’s surprising this is a raging controversy. The fact that breastmilk is healthier comes into direct conflict with the extreme difficulty some people have establishing breastfeeding, at a time when they have just had one of the most traumatic experiences of their lives. In some cases a bottle is the only way. I don’t envy midwives having to hold out hard against a device that provides so much instantaneous relief, and in a small number of cases, the holding out produces suffering that could, in hindsight, have been avoided.

Blaming midwives for policing breastfeeding is a bit like blaming parking wardens for writing tickets. Both are implementing official policy.

Breastfeeding evangelists – of both genders – are influential in government ministries, and not only in Health.

For example, in the Ministry of Justice’s Performance Monitoring Measures for Drivers of Crime, apparently approved by Cabinet in 2011:

“Increase breastfeeding rates at 3 months of age” is included as a “priority outcome indicator” for the outcome: “Improving the quantity, quality and effectiveness of maternity and early parenting support services, particularly for those most at risk”

I disagree slightly @insider, what is healthiest is that the baby gets adequate nutrition. It doesn’t matter if there is a loving relationship if the baby is starving. Something that I have seen happen when a mother is not supported to supplementary feed with formula when their breast milk is not nutritious enough.

It’s pretty obvious that there’s a conflict of rights here. The interest of the child in optimal nutrition (which is optimised (with exceptions) by exclusive breastfeeding in the first 6 months), the interest of the child in establishing a bond with its mother, the interest of the mother in establishing a bond with her child (which may be facilitated or impaired by breastfeeding practices), the interest of the mother in maintaining bodily integrity, the interest of the mother in avoiding pain and other harms, the interest of society in growing healthy children, the interest of society in empowering women. I’m sure there are others I’ve missed here.

Anyone who holds any one of these as trumps is bound to see conflict. But that’s not happening, at least not often. What instead is happening is that people are prioritising one or another over others, weakly or strongly, but not being explicit. Very often they claim to be optimising everything. That is not possible; whatever decision is made is one that will be imposed on a body (either that of the child or the mother).

Could have been worse – at least nobody’s telling NZ mums that formula is like AIDS. There’s certainly a strain of back-to-nature ideology in this field that comes out when its proponents get away on themselves and forget what it’s like to have to return to work at 14 weeks, or arrange childcare when you’re hospitalised with mastitis.

I think the ‘controversy’ stems more from the perception of midwives as being ‘touchy feely’ liberal types. If the pro-breastfeeding message were coming from Victorian era (conservative) matronly nannies many of those feeling affronted wouldn’t even bat an eyelid – “Yes nanny.” But because it’s perceived to be coming from the ‘PC Brigade’ it’s another story completely.

I knew that the La Leshe (?) League were ‘on the war path’ in the hospitals for both our children – so I carried a bottle with formula ready to mix up in my pocket, and put formula sachets in my wife’s bag for later.

Both our two children were Cesarian (on doctors advice – there’s another bunch of over zealous midwives – the ‘natural birth-ers’) and so her milk didn’t start for several days. Both boys had half a bottle within hours of being born. And if it was not for the bottle, my wife only produced milk on one side, and never enough. So our children were fed breast for as much as they could get then topped up with bottle. That way they got enough nutrition and all the health benefits of mother’s milk.

That is something they never tell you – you can do both, and do it successfully.

We did meet a lot of really crazy mid-wives when Sadie was born. My favorite was the lactation teacher who told her class that women who bottlefed wouldn’t get hired when they tried to go back to work, because employers preferred mums who breastfeed. Amusing – but some mums I know who couldn’t breastfeed were bullied terribly. It’s a weird profession.

Both our two children were Cesarian (on doctors advice – there’s another bunch of over zealous midwives – the ‘natural birth-ers’)

This statement seems a little out of context.
Were the pregnancies managed by a midwife or an obstetrician?
Was the doctor advising a caesarian procedure (a) your obstetrician (b) the duty consultant on the day of the birth?
The reason I ask is that if the pregnancies were under the management of an obstetrician the midwives wouldn’t careso much, but if it was being managed by a midwife they would as they have a duty of care.

Principally;

(a) surgical intervention in birthing should be a last resort – it’s both expensive and circumvents the natural processes of birthing, meaning that hormone production / healing is delayed

(b) midwives only get full payment for services based on a non-surgically assisted birth.

13.I wonder what we did before “formula” arrived? – Comment by peterlepaysan

We watched our children die. The good old days, eh? Some environmentalists want to take us back to those days. Perhaps they feel that the mental effect of a loss of a child is a natural-thus-healthy thing.

Both were midwife managed – but she told us to seek medical advice which is why my wife ended with a caesarian – after trying everything else to induce with no result. I was very pleased with the level of care our midwife provided – very helpful, but knew when to take a step back and involve more specialist care – I have only the highest praise for her. And also for the Hutt Hospital surgical team that performed the operation under epidural not full anesthetic so my wife was conscious throughout.

True – caesarians should not be used for convenience, but there are medical reasons for carrying out them – our two children case in point. Natural childbirth has its own risks and at times you just have to weigh up the risk either course of action and take the one most prudent for the situation – but we wanted natural births if possible – thus used a midwife each time as lead carer, it just didn’t work out that way each time.

Have no problem with the midwife/hospital – however the La Leche lady at the Hutt Hospital was a dried up prune of a woman who, by her own admission had no children of her own and was quite nasty to my wife when she ‘discovered’ her supplementary bottle feeding our first born, so I told her to p*ss off when I found out she was hassling my wife over it. That sort of moralistic guilt trip is the last thing a new mother needed. The second time around, it was a different person, and my wife, now with this a second child told her to b*gger off herself before I even realised she was being hassled again.

P.S. For those that ask what we did before formula, there was always the wet-nurse – usually a woman who was still breast feeding (and was a generous producer) or was still producing milk after her baby had recently died was bought in to feed your baby – or goat milk (which is much closer to human milk than cow) was used. I understand pap was used as well.

Yes the wealthy could afford to pay for a wet nurse as a dedicated employee so the wife did not have to spend a great deal of time feeding their child and the wet nurse had little else to do. For the very rich, they often prevented the wet nurse from nursing her own baby in case that took milk that the noble child would need – in that case the paid wet nurse ‘farmed’ her own child out to a relative/neighbour (and paid some of her own wages to them). It is this form that often appears in literature and so is much better known as the lives of the lower classes were not generally documented. A wet nurse, given that it involved very little hard work was a prized job and much sort after. It also had a significant prestige, as nobility was considered special, thus feeding a noble child was also special – and there was generally the chance of additional rewards later.

But if you look into it deeper wet nursing was far more common than you might have thought – however most were not paid specifically as a wet nurse (even as a form of domestic servant) – if you were breastfeeding your own baby and had plenty of milk or had just weaned/about to wean and your relative or neighbour could not breastfeed you would likely feed theirs as well – often for other considerations – they’d barter food in return or cook/clean while you fed – the wider community generally rallied around to ensure babies did not starve if there were other options.

Are you sure the dried up prune of a woman with no kids of her own was a Le Leche lady? The Le Leche League leaders are almost always (if not always) mothers with past experience of breast feeding. I used to be married to a LLL leader (who is rather prune like I admit).

I am also surprised by the messages above about LLL leaders working within hospitals. I do not think that would be common practice unless the LLL person is invited in by the mother. The Breastfeeding advice in hospitals comes from midwives and lactation consultants, and most provide a good service and common sense.

The real villians are the New Zealand Breastfeeding Authority. Their job is to promote and support the Baby Friendly Hospital Initiative and the Baby Friendly Community Initiative. It was at their suggestion that breastfeeding mothers staying with sick children in my childrens ward be given free meals, while bottle feeding mothers had to buy their own. How F***** up is that?